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Youth Request for 2012
Your Email Address:
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Date of Birth:
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Ice Hockey involvement in 2011/12:
Roller Hockey involvement in 2011/12:
Height
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124cm - 4ft 0in
126cm - 4ft 1in
128cm - 4ft 2in
130cm - 4ft 2in
132cm - 4ft 3in
134cm - 4ft 4in
136cm - 4ft 5in
138cm - 4ft 6in
140cm - 4ft 7in
142cm - 4ft 7in
144cm - 4ft 8in
146cm - 4ft 9in
148cm - 4ft 10in
150cm - 4ft 11in
152cm - 4ft 11in
154cm - 5ft 0in
156cm - 5ft 1in
158cm - 5ft 2in
160cm - 5ft 2in
162cm - 5ft 3in
164cm - 5ft 4in
166cm - 5ft 5in
168cm - 5ft 6in
170cm - 5ft 6in
172cm - 5ft 7in
174cm - 5ft 8in
176cm - 5ft 9in
178cm - 5ft 10in
180cm - 5ft 10in
182cm - 5ft 11in
184cm - 6ft 0in
First choice Shirt number
Dont mind
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Second preference Shirt number
Dont mind
1
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98
Shirt Size
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XL
L
M
(All sizes are adult)
Name wanted on back of shirt
Playing position
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Forward
Defence
Either Forward or Defence
Goalie
Phone number (Home)
Phone number (Mobile)
*
Mailing address
*
List any dates that you are not available to play
List names of any players you would like to play alongside.
(We can not guarantee a placement in any friend's teams)
*
I understand and accept that the neither the Thames Valley Summer League nor its organisers will take any responsibility or liability for any injury, loss or damage incurred as a result of events happening within the competition.